從多重理論模式綜觀乳癌倖存者過渡期照護之影響因素與介入策略

A Survey of the Factors of Influence and Interventional Strategies for Breast Cancer Survivors' Transition Care Across Multiple Theoretical Perspectives

乳癌疾病高度威脅婦女的存活，且治療所致的負面效應嚴重地降低婦女的生活品質與心理安適，過渡期之照護品質是影響乳癌婦女從患者過渡至倖存者階段的關鍵時刻。本文提出以社會生態學模式為主，參考Dr. Meleis過渡理論為架構，檢視影響乳癌倖存者過渡期之照護，探索的層面包括個人、人際、組織、社區及政策層級等因素。本文同時整合優勢觀點，依據各層級之優勢提出實徵性研究結果的可能介入措施，企圖契合本土社會文化之脈絡與臨床實務之運用，以提升國內乳癌婦女的整體性照護方針。醫療保健提供者應能識別判斷婦女立身所處之系統和過渡期中各層級的情境優勢和資源所在，並妥善發展可行的策略，以成功地協助乳癌婦女從罹病治療結束後安穩過渡到倖存者階段，以整體促進婦女生存期間的關照內涵與生活品質。

Breast cancer significantly threatens the life of women, while the adverse effects of cancer treatment degrade quality of life and psychological well-being. The quality of transitional care following the completion of treatment significantly affects the ability of breast cancer patients to transition successfully into survivorship. This paper introduces multiple theoretical perspectives and provides an overview of the tenets of each in order to identify the positions of breast cancer survivors and to highlight the factors and strategies that influence their transitional care. The theoretical perspectives that are introduced include the social-ecological model, transition theory, and the strengths perspective. In order to improve the holistic care of women with breast cancer, factors relevant to transition are categorized into the individual, interpersonal, organizational, community, and policy levels. Furthermore, empirical interventions, which are based on the respective advantages of the various levels of the social-ecological model, are proposed in order to conform to the sociocultural context and clinical practices. Healthcare providers should leverage the strengths and resources at each level to develop feasible strategies and to provide quality of care in order to assist breast cancer patients to transition successfully from treatment to survivorship and to holistically improve their subsequent quality of life and function.